| A Grounded Theory method was used to examine the perspectives of fourteen women of diverse, racial/ethnic backgrounds, ages, educational levels, and insurance coverage. The findings revealed the core dimension of Relational Power throughout the three dimensions of Self in Relation to the System, Self in Relationship with Provider, and Perceived Quality of Service. Self in Relation to System included three sub-dimensions: type of insurance, using education, and connections to health care professionals. Self in Relationship with Provider was comprised of three sub-dimensions: communication, trust, and knowing/being known by provider. Perceived Quality of Care was divided into the three sub-dimensions of medical competency, relational competency, and time. The Relational Power dimension that emerged in the context of the other three dimensions consisted of two sub-dimensions: providers' expressions of power and women's strategies to negotiate power differentials. Sub-dimensions consisted of categories that further defined the constructs. The findings suggested two levels of cultural health care barriers: one at the organizational level and the other at the interpersonal level. Organizational barriers included: (a) limited access to services based upon one's limited or lack of insurance coverage and the high cost of care, (b) delayed access because it was difficult to schedule an appointment in a timely fashion, (c) discontinuity of provider which precluded relationship development, (d) restrictions on referrals to specialists, (e) brief clinic appointments which limited information sharing, (f) language barriers because English was the woman's second language and no interpreters were available or providers used esoteric medical terms. Interpersonal barriers included (a) inadequate service because of provider's rude, indifferent, or prejudiced attitudes which also precluded relationship building, (b) inadequate service related to providers rushing or not listening, (c) providers withholding information and/or treatment options, (d) provider's insensitivity to issues of gender and culture, (e) provider's insensitivity to women's psychosocial needs, and (f) discriminatory care. A relational approach to multicultural care was proposed. This model extends existing multicultural models in nursing by emphasizing interpersonal skills central to building relationships and empowering patients in addition to self-awareness, cultural knowledge, and cross-cultural communication skills. |
